Several CIRG members had the opportunity to attend FIS 2021 this year, the Federation of Infection Societies Annual Conference. It was all-round a wonderful conference, with some excellent opportunities to hear about exciting new research and plenty of networking!
We’re also delighted to announce that CIRG’s Dr Meghan Perry was an author on a poster at the conference that won a Healthcare Infection Society Poster Prize. It was titled ‘Risk factors for antibiotic resistance in patients with Escherichia coli (E. coli) bacteraemia from urinary tract infections (UTIs)’ and was authored by James Balfour along with Mabel Barclay, Jonathan Daniels, Carol Philips, Michelle Etherson, Meghan Perry, and Naomi Henderson.
We’d like to extend our congratulations to all the authors!
Abstract:
Introduction
NHS Lothian policy has recently changed to avoid first-line use of trimethoprim for uncomplicated UTIs in patients with risk factors for resistance, in line with NICE guidance. This study aimed to identify local risk factors for antibiotic resistance in Escherichia coli bacteraemias related to UTI.
Methods
A retrospective cohort study of 687 patients with E. Coli bacteraemia related to UTI in NHS Lothian from 01/02/18-29/02/20. Duplicates excluded. Demographics, clinical data, and co-morbidities were collected from Trak(electronic patient records). Community antibiotic prescribing and microbiology data were collected from Prescribing Information System(PIS) and Apex. Univariate analysis and multivariate logistic regression using RStudio examined risk factors for trimethoprim resistance (TR) and multi-drug resistance (MDR). MDR was defined as resistance to at least 1 drug in >3 antibiotic categories.
Results
TR was found in 282/687(41%) bacteraemias. Multivariate modelling showed increased TR in previous urinary TR E. Coli(OR=8.56, P<0.001), previous antibiotic prescription(OR=2.05, P<0.001), trimethoprim prescription(OR= 2.71, P<0.001), trimethoprim course number(OR=1.66, P<0.001), antibiotic course number(OR= 1.24, P<0.001), and prophylactic antibiotic prescription(OR=3.03, p=0.003). MDR E. coli were found in 278/687(40.5%) bacteraemias, 226/278(81.3%) were TR. Predictors of MDR included previous antibiotic prescription(OR=1.87, P<0.001), antibiotic course number(OR=1.26, P<0.001), trimethoprim(OR=1.96, P<0.001), nitrofurantoin(OR= 2.17, p=0.002) and prophylactic antibiotic prescription(OR=3.60, P<0.001).
Discussion
The data shows a high prevalence of TR and MDR in patients with E. coli bacteraemia related to UTI. This study supports the withdrawal of trimethoprim from first-line use for UTIs in patients with risk factors for TR and has identified risk factors for MDR in E. coli bacteraemia.
